Tag Archives: Patient Protection and Affordable Care Act

Straight, No Chaser: End of Life Decision Making

General Health and Wellness, Medical Treatment, Health Prevention, , , , , , , , , , , , , , , , , , ,

end-of-life_tcm7-91616

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

AdvanceDirective

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document, and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That scenario doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
    • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering, or will you want to be allowed to die?
    • Will you want the medical staff to feed you if you can’t feed yourself?
    • Will you want to donate your organs?

endoflifedeath

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser In The News: The Real Meaning of the American Health Care Act and of Replacing the Affordable Care Act

General Health and Wellness, , , , , , , ,

Here’s the thing. It’s only one view that America bends toward an arc of diversity, inclusion and justice. There is another view – felt to be every bit as compelling to those who just happen to be represented by those who won the last election and control the various branches of government. In this view, personal responsibility and individual freedoms are the compelling freedoms of America, and redistribution of wealth toward the less fortunate is labelled an “entitlement” instead of part of what binds a nation together.

These competing interests have long played out in healthcare. It explains the reason that America has long been the sole major industrialized nation in the entire world that doesn’t provide universal health care and, by a large amount, demonstrates disparities in healthcare largely attributable to one’s financial status.
To say that America is a democracy is to say there are roughly equal parts liberal and conservative forces that can influence policy if and when given the opportunity. However, America is a capitalist nation without a counterbalancing force toward socialism. Historically, part of the social construct of nations with its citizens has been to, at a minimum, provide certain protections equated with socialism, including health, education, welfare and police protection. It is of interest to note that, in our capitalist society, there have always been efforts to further the capitalist experience and privatize these fundamentals. In the example of healthcare, these forces have outweighed the calls from those seeking universal healthcare or consideration of healthcare as a right.

It is in this vein that I view the current conversation on health care. One must appreciate the United States does not have a healthcare system. We have a healthcare industry that represents 1/6th (17%) of the U.S. economy (comparatively, the next largest country spends approximately 11% of it’s gross domestic product on healthcare). Appreciate this point. Of all the corporate “too bigs to fail,” the healthcare industry is especially legitimate. To shrink the healthcare industry by compelling a truly socialist healthcare system (meaning assets are owned and run by the government, complete with cost controls) would drive so many industries out of business, it would crash the economy beyond recognition. Right about now, for those of you who’d state that “healthcare for all” is the “right thing to do,” I should remind you that capitalism has no moral check. It’s governing principle is the so-called “invisible hand,” describing a force in a society in which everyone is pursuing their own individual gains, and in which the sum total of these efforts will generate desired end results across the board.
And so with healthcare, the purely capitalist approach would be to deliver care in total to the markets and the entrepreneurs chasing profits. Theoretically, competition would drive down costs and increase services in order to better attract customers. In this example healthcare outcomes are an offshoot of the industry, not the primary concern of a system.

Let’s look at five defining features of the American Health Care Act. I’ll list some facts first, then provide a bit of commentary.

  1. There will no longer be either a requirement or an entitlement to have health insurance. Of course this means there will no longer be a government-sanctioned entitlement to healthcare for all. If you believe in “personal responsibility,” you applaud this consideration. If you believe in a “social safety net,” not so much. Additionally, many of the taxes in place to fund the ACA would be eliminated.
  2. There will no longer be an employer mandate to provide health insurance. The employer mandate, which required companies with 50 or more full-time workers to offer insurance or pay a tax, will be going away. For many, the first impulse is to ask how employers could be so heartless. For others, the first question involves why employers have to provide insurance anyway. It was established a century ago as a competitive measure by companies, and later it became a requirement with the success of American unions. It just happens to be the case that the same levels of competition for employees and needs to provide benefits no longer exist, and employers are anxious to enjoy greater profits where possible.
  3. The Medicaid expansion created with the Affordable Care Act (aka ACA, Obamacare) will be phased out by 2020. For states having accepted the expansion, this will affect low-income families, pregnant woman, children, the disabled, and those over age 65 with incomes up to 138% of the federal poverty level (about $16,643). In this context, phased out means there will be no new enrollment and anyone allowing a lapse in coverage for more than one month will not be allowed to enroll.
  4. If you have commercial insurance, the so-called essential health benefits established under the ACA will remain. These include maternity care, mental health care and prescription drugs. Beginning 2020, state Medicaid plans would not have to meet this requirement. Additionally, young adults under age 26 will still be able to remain on their parents’ plans and insurance companies will not be able to deny insurance to those with preexisting insurance, given these individuals have preexisting insurance. However, under certain conditions, insurance companies will be allowed to charge up to 30% higher premiums for one year to such individuals.
  5. Financial assistance to help purchase insurance will change significantly from the ACA. The new plan would shift tax credit to those purchasing insurance away from income-based considerations to age-based considerations, even though insurance companies will be allowed to charge the elderly up to five times more for coverage than younger Americans. The net effect of this will be a lot less use of the system. Your insurance card will have a lot less value dollar for dollar compared to what you’ve had historically.

If you are in a rush to declare this bill a failure, it’s because you are of the mindset (in step with the rest of the world) that health care is a right, and insurance is necessary to provide healthcare. Of course, the point is that’s not the objective of those seeking to eliminate the ACA; in fact, the plan retains many, if not most of the programmatic elements of the ACA. It’s not just the ACA that these politicians are looking to eliminate. It’s the idea that healthcare is a right. It’s any notion that the government should financially support an entitlement. It’s the notion that the free market wouldn’t best regulate services and costs. It’s the notion that employers should be forced to provide benefits in this manner. So when the Congressional Budget Office tells you that between 6-10 million less people will be insured than currently are, and there won’t be cost savings to the citizenry, remember: that never was the objective. Remember this, which is perhaps closer to the true motivation of those perpetually inclined to distract you while pursuing truer interests in a stealth manner: the 400 highest-earning households in the country would get an average tax break of $7 million per year under the proposed American Health Care Act.
In the meantime, here’s what is expected to complete “access to care” for all of the newly uninsured.

Feel free to ask your Sterling Medical Advice expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

General Health and Wellness, Medical Treatment, Health Prevention, , , , , , , , , , , , , , , , , ,

end-of-life_tcm7-91616

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

AdvanceDirective

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document, and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That scenario doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering, or will you want to be allowed to die?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

endoflifedeath

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser In The News: Presidential Candidates' Views, Public Opinion and the Future of Obamacare

Public Health, , , , , ,

obamacare approved

Let’s go off the grid and take a look at the intersection of Presidential politics, health care and public health. Of the three remaining Presidential candidates, each has a distinct point of view regarding the future of the Affordable Care Act (ACA, aka Obamacare).

  • Hillary Clinton generally says she would keep the ACA in place.
  • Bernie Sanders calls for replacing the ACA with a single-payer, federally administered system: “Medicare for All.”
  • Donald Trump has said he would repeal the ACA.

obamacareclinton

Approximately two weeks ago, Gallup polled Americans on these thoughts without identifying the Presidential candidate associated with the viewpoint. Consistent with past findings, the majority of US citizens support the idea of a fully federally funded healthcare system. Here’s the breakdown of those individual views.

  • 58% favor replacing the ACA with federally funded healthcare system;
  • About half would also be ok with keeping the ACA as is; and
  • Just over half would favor repealing the ACA. However, only 22% of Americans say they want the ACA repealed outright; those favoring repeal largely favor replacing it with a federally funded system such as the even more liberal “Medical for All” option.

sanders obamacare

The partisan division of reactions to these proposals by partisanship shows the expected patterns: Democrats and Democratic-leaning independents are highly likely to favor the two governmental options (retain the ACA or move to “Medicare for All”), while Republicans and Republican leaners are highly likely to favor repeal of the ACA.
Republican presidential candidate Donald Trump speaks at a campaign stop, Wednesday, March 30, 2016, in Appleton, Wis. (AP Photo/Nam Y. Huh)
Historically, when given a choice, Americans are philosophically more inclined to favor a private healthcare system than one run by the government. Americans are generally satisfied with their personal healthcare. Unfortunately in this example the mere statistics have never told the complete story. Even with a 90% satisfaction level, that leaves over 30 million Americans completely without healthcare and inclined to be completely dissatisfied. Here in this life or death paradigm, the “majority rules” consideration just isn’t enough to overlook the needs of the minority.
It will be interesting to see how the debate is framed as things move forward. In the meantime, it is also of interest to also note that in the news is the drop of the uninsured in the US to single digits for the first time in generations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

General Health and Wellness, Medical Treatment, Health Prevention, , , , , , , , , , , , , ,

end-of-life_tcm7-91616

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

AdvanceDirective

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document, and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That scenario doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering, or will you want to be allowed to die?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

endoflifedeath

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

General Health and Wellness, Medical Treatment, Health Prevention, , , , , , , , , , , , , ,

AdvanceDirective

Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering or will you want to be allowed to expire?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

Public Health, , , , , , , , , , , ,

healthcareranking_graphic-6eff0c2bd2a652909496b46ab1151c20ccf871f1-s6-c30

As we begin 2014 with the implementation of the Affordable Care Act and states’ implementation of Medicaid expansion (well in most of the country), it bears reviewing why this was necessary. Joining me in this conversation is Dr. Bill Vostinak, a prominent orthopedist.
Prior to approval of the Affordable Care Act, and in spite of the loud and incorrect proclamations that we have the “best healthcare system in the world,” the U.S. would have been easily challenged on its purported effectiveness of our healthcare system based on a simple review of the following objective data points. (Our apologies in advance to those who value opinions over facts—or math.)

healthcarespending_expenditure200-3135fdaf60226020bef119d47535ab3022860d7c-s6-c30

Let’s start by appreciating just how much the U.S. has been spending on our healthcare system and what type of access Americans have had to it.
The U.S., by a large margin, has the highest healthcare expenditures in the world. We spend approximately 17% ($1 in every $6) of our gross domestic product (GDP) on healthcare. The next closest nation spends 11%. (For clarification, that’s an incremental increase from the above chart of 2000.)
Despite our exorbitant national costs, only 84.9% of U.S. citizens have healthcare insurance. That translates to 50 million Americans who were uninsured prior to today. We rank 33rd in the world.
Have you ever heard the quote that “85% of Americans are happy with their healthcare?”  (Congratulations if that statement applies to you.) Do you realize that in a nation of over 320 million, that leaves 48 million Americans unhappy? Even if you got past the “48,000,000″ number, which is a massive number of citizens, consider the 85% number.
This is America. 85% is barely a B-grade in school. Is that the standard we seek? And … do the math. Notice the nearly exact match, likely not coincidental, between the number of individuals dissatisfied with their healthcare and the number of uninsured Americans. Basically, you’re satisfied if you have insurance, and if you don’t … not so much. Alternatively, 85% satisfaction may be based on the perception of insurance carrying the individual’s burden of medical costs.
Now let’s move to quality.
In an infamous ranking of healthcare systems around the world, the World Health Organization (WHO) ranked the U.S. system 38th based on routine outcomes-based metrics such as disability-adjusted life expectancy, speed of service, protection of privacy, quality of amenities, and fairness of financial contribution. WHO Ranking
Amid predictable criticism of the U.S. regarding the WHO study, Bloomberg performed its own analysis  and discovered that among advanced economies, the U.S. spends the most on healthcare (on a relative cost basis) with the worst outcome. Bloomberg ranked the U.S. 46th among all nations in efficiency given the average expenditure of $8,608 per year per individual. Bloomberg Report
In terms of infant mortality, about 11,300 newborns die each year within 24 hours of their birth in the U.S., with 50 percent more first-day deaths than all other industrialized countries combined. Infant Mortality
Save the Children’s 14th annual “State of the World’s Mothers” report ranked the U.S. 30th out of 168 countries in terms of best places to be a mother. Criteria included child mortality, maternal mortality, economic status of women, educational achievement and political representation of women. SaveTheChildren.org
An important distinguishing factor in comparing U.S. healthcare with other systems is tying it to employment rather than citizenship. Labor and other costs of American goods and services make it difficult for American corporation to compete in world markets. Add the large fixed cost of healthcare, and competing is nearly impossible.
It is reprehensible to suggest that the effort to cover 50 million uninsured Americans is some socialist plot or anything other than the humane thing to do. Let’s just stop with the selfishness and nonsense about there being no value to the efforts being made to improve access to/quality of healthcare (which reintroduces preventive and mental healthcare considerations) than we had previously. If you don’t believe us, just do the math. Even after a full implementation of the ACA, estimates suggest than some 20 million Americans will still be uninsured.
America is alone among the major industrial nations of the world in not having universal healthcare. That’s the collective decision of the country. Hopefully, these most recent steps through the ACA will represent significant steps toward efficiency, effectiveness and full inclusion. So, how do other countries deliver quality care for less? We’ll save that for another discussion.
Feel free to ask your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: A Solution to the Upcoming Healthcare Crisis and the Affordable Care Act

General Health and Wellness, Public Health, , , , , , , , , ,

logo
Many of you have heard or seen me discuss various aspects of the Patient Protection and Affordable Care Act.  This ambitious effort seeks to maintain the current level of quality that exists (via maintaining the same insurance coverage for those individuals that already have it), while adding approximately 30 million individuals to the insurance rolls while not increasing overall system costs.
Have you noticed that one part of the conversation that doesn’t seem to occur is “Who’s going to take care of these 30 million new individuals? Also, what about the other 20 million that still won’t have insurance?” The twin deterrents of co-pays and deductibles will eventually be stiffened to curtail over- and inappropriate utilization of the emergency room for both the newly insured and the uninsured voucher recipients (Besides, who wants to deal with the long wait times both in your physician’s office and the ER, soon to be even worse with all the newly insured?). Similarly, you would presume that armies of new physicians are being trained to meet this growth in the newly insured, but that simply isn’t the case. Additional options to address this influx will be necessary. Prominent among these options will be those providing better education and greater empowerment of patients to direct their own care.
Sterling Medical Advice (SMA) is a national public health initiative that provides a solution to these issues by the introduction of 24/7 online personal healthcare consulting, featuring physicians and other care professionals covering the entire spectrum of medicine and healthcare. Consultations will be personalized and immediately available to those in need around the clock.
“What’s that, and when might you use it?” Here are a few examples.

  • You need advice regarding an immediate medical concern
  • You need general information about your medical condition
  • You need immediate information about your prescription
  • You are experiencing symptoms and want to know why
  • You want to learn more information about a medical condition that is part of your family history
  • You want additional details on your upcoming medical procedure
  • You need advice regarding the best care option for addressing a medical concern (e.g., emergency room vs. urgent care vs. scheduling an appointment with your primary care physician)
  • You want a second opinion on your new diagnosis
  • You want a second opinion on your new treatment plan
  • You need additional information about what to expect from a newly diagnosed condition

Sterling Medical Advice will improve public health outcomes while reducing healthcare costs for individuals, families and businesses and the healthcare system at large. Personal healthcare consulting will create a better-educated and empowered population and will become an additional component to the American health care system without compromising quality.
To find out more about Sterling Medical Advice, visit www.sterlingmedicaladvice.com, and thanks for following Straight, No Chaser.

Straight, No Chaser: Revisiting the Affordable Care Act – How You or Your Employer Can Save Up to 50% of HealthCare Costs

General Health and Wellness, Health Prevention, , , , , , , , ,

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Politics aside, I’m not so sure why business owners are focusing on the angst of implementation of the Affordable Care Act instead of the opportunities to save.
Consider the following from the Small Business Association website: “The Affordable Care Act (ACA) creates new incentives for employers to promote wellness among employees by creating supportive, healthier work environments and encouraging employees to take advantage of workplace wellness programs. Health-contingent wellness programs generally require employees to meet a specific standard related to their health, e.g., decreased tobacco use or lowered cholesterol levels. Under the ACA rules that take effect on January 1, 2014, employer rewards will increase from a 20–30% refund of their healthcare coverage costs for employing health-contingent programs, up to 50% for programs designed to prevent or reduce tobacco use.”
Subscribing to www.sterlingmedicaladvice.com as an employee benefit will save companies up to half of the insurance costs they are already paying for their employees.  These savings can occur at a cost of less than 10% of current costs of insurance! For more information about the final rules’ flexibility in eligible wellness programs, visit www.dol.gov/ebsa.  Have your employee assistance program administrator contact us at 1-866-ADVICE3 (238-4233) or email us at sales@sterlingmedicaladvice.com.

Looking to cut your ACA tax in half? Sign up with SMA, reduce absenteeism, win the appreciation of your employees, and save a bundle.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: It's October 1st – Do You Know Where Your Affordable Care Act Health Insurance Exchanges Are? Your Top Ten Questions

Public Health, , , , , , , , ,

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No politics here folks, just facts. The bottom line is the Affordable Care Act (ACA) isn’t going anywhere prior to implementation, so let’s look at where things are. You can go here for previous comments on the ACA.
1. What changes today? The exchanges as scheduled to open for administrative business and to begin signing up customers. This is expected to affect approximately 30 million Americans who previously had not been covered by insurance plans. However, online enrollment has been delayed until November. It is still thought this won’t delay the onset of benefits.
2. Do I qualify for an exchange? You do if you are an employee of a business with less than 50 employees and have to buy your own insurance, and if you currently can’t get insurance because of a preexisting medical condition, or you can’t afford the cost.
3. So do I have insurance today if I enroll? No. Benefits begin on January 1st.
4. What about the individual mandate? It’s still in effect. Starting January 1st, most Americans must either be insured or face a fine.
5. What about the employer mandate? It’s actually been delayed until 2015. This mandate requires any company with over 50 employees to offer benefits to anyone working more than 30 hours a week.
6. Is any of this affected by the governmental shutdown? No. In short, funding for the ACA is not under the control of Congress.
7. How do I know what’s happening in my state? 16 states plus the District of Columbia are setting up their own exchanges. The other 34 states  are being run either totally or partially by the federal government. Refer to the lead picture to see what your state is doing, then go to www.healthcare.gov for details.
8. How does the insurance provided by the exchanges compare with that of traditional insurance? Different exchange plans will have different levels of coverage (eg.bronze, silver, gold and platinum). You’ll get to select a plan based on your needs.
9. What about the costs? This is tricky. Obviously, the plans differ based on the one selected. Additionally, if you’re below 400% of the poverty level (which equals $45,960 for an individual and $92,200 for a family of four), you’ll be eligible for tax credits to bring down the costs of the respective plans. In general, the costs of individual insurance within the exchanges will be dramatically lower than private insurance for those who qualify.
10. Where do I sign up and/or get more information? Try www.healthcare.gov.

Straight, No Chaser Editorial: The Future of Medicine – Nurses are Stepping Up to the Plate

Public Health, , , , , , , ,

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I doubt you’ll hear this perspective anywhere else anytime soon, but there are some very interesting developments in health care underway. By way of introduction, a few decades ago, physicians abdicated the ownership and preeminent leadership role in healthcare, leaving the industry to the business minds of HMOs. During these early days, non-physician corporations actually owning medical practices and developing practice parameters were outlawed as to ensure that sufficient protections would remain in place for autonomous (and presumably honorable) medical practice. 
The combination of for profit hospitals and the advent of contract medical practice management groups (particularly in emergency medicine, hospitalist medicine and radiology) combined to erode away at the corporate practice of medicine laws to where even though the laws are still on the books, suits to enforce it are now routinely defeated. Today, in addition to emergency room physicians, radiologists, surgeons, hospitalists, and anesthesiologists are more likely to be employees than owners of a practice.
In recent times, health care costs have skyrocketed to 17% of our economy, while 50 million Americans went without insurance. Meanwhile, the combination of a shortage of primary care physicians and for-profit entities’ desire to cut costs has led to the development and proliferation of alternative, less costly methods of paying individuals to provide health care. Most notably, this has included the development of advance practice nurses (e.g. nurse practitioners and nurse anesthetists – instead of family doctors and anesthesiologists). Similar interest in cost savings has led to nurses assuming senior managerial positions in hospitals instead of MBA-type executives.
It is against this backdrop that the Patient Protection and Affordable Care Act (aka ‘Obamacare’) passed, seeking to infuse 30 million more paying patients into the primary care arena. With ongoing physician shortages unable to meet this demand, and with there being downward cost pressure on salaries due to the goals of the ACA and desires of corporations, it’s reasonable to predict that we will see a dramatic increase in primary care nurse practitioners (NPs) and physician assistants (PAs), which will lead to further abandonment of primary care as a physician specialty.
Meanwhile, nurses have stepped up to fill the void.  In addition to the ongoing advancement of Nurse Practitioners, nurses have successfully lobbied for and created a new provider entity: ‘The Doctorate in Nursing Practice’. It is important to note that NPs and PAs can successfully treat about 85% of the things physicians routinely see. Quality concerns aside, it is an important public health consideration that additional healthcare professionals and health options are being established to fill the need of care for tens of millions of individuals more likely to use the healthcare system.
Meanwhile, regarding your doctors, a conceivable end result is physicians are being marginalized in virtually every aspect of health care. It is easy to see a future in health care 25 years from now where cost concerns have been addressed by nurses having replaced physicians in more specialties than just primary care and anesthesia, and nurses have more control of the hospital apparatus than physicians. Physicians remain oblivious to what’s happening under their noses and an insufficient interest in contributing to healthcare solutions in the ways nurses have. The Straight, No Chaser perspective is given the large segments of society that continue not to have access to care (even with implementation of the Affordable Care Act, it is estimated that 20 million American still won’t have insurance), new innovative options to address these needs are welcome and have a place in the system. What’s next is for society to ensure that this transition occurs with appropriate quality controls and public education.
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Straight No Chaser: Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)



Public Health, , , , , , , ,

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In general, the Patient Protection and Affordable Care Act (ACA) attempts a nifty set of tricks: it aims to add over 30 million currently uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need. 

The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1)    The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2)    Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3)    Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4)    Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5)    Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6)    Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7)     End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care.  Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations.  As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care.  I would challenge all the critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
I welcome your comments and questions.
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Straight, No Chaser: A Dream of Equal Access to Health Care

Public Health, , , , , , , ,

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This weekend marked the celebrations of the 50th anniversary of the famous March on Washington. During this weekend’s remembrances, I couldn’t help but reflect back on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”

Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected. I will be frequently reviewing these considerations and addressing health care disparities in this blog. Today, I will address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often can’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screaming to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of last year. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured over $2 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. The Affordable Care Act (ACA) targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. This afternoon I will revisit the Affordable Care Act and it’s efforts to improve the current system. I welcome any questions or comments.
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Straight, No Chaser: End of Life Decision Making

Medical Treatment, Health Prevention, , , , , , , , , , , , , ,

AdvanceDirective
Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering or will you want to be allowed to expire?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.